Opioid Prescribing in Medicaid: Healthcare Utilization and Deaths from Overdose

医疗补助中的阿片类药物处方：医疗保健利用和过量死亡

• 批准号: 9229541
• 负责人: Jayani Jayawardhana
• 金额: $ 22.5万
• 依托单位: UNIVERSITY OF GEORGIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9229541
• 关键词: Acute Pain; Address; Awareness; Behavior; Benzodiazepines; Caring; Cessation of life; Community Health; Control Groups; Criminal Justice; Data; Death Rate; Dose; Drug Prescriptions; Effectiveness; Enrollment; Formularies; Health; Health Care Costs; Health Personnel; Health Professional; Individual; International Aspects; Lead; Least-Squares Analysis; Measures; Medicaid; Medical; Medical Assistance; Medical Care Costs; Modeling; Natural experiment; North Carolina; Opioid; Opioid Analgesics; Outcome; Overdose; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Policies; Policy Maker; Population; Population Group; Public Health; Public Health Schools; Research; Risk; Substance Use Disorder; Techniques; Testing; Time; United States; United States Centers for Medicare and Medicaid Services; Universities; Vulnerable Populations; Woman; Work; college; cost; demographics; design; drug misuse; expectation; health care service utilization; health service use; improved; innovation; men; misuse of prescription only drugs; opioid misuse; opioid use; overdose death; prescription drug abuse; prescription opioid; prescription opioid abuse; programs; public health relevance; service utilization; socioeconomics; statistics

 DESCRIPTION (provided by applicant): The misuse and potential inappropriate prescribing of prescription opioid analgesics is a growing public health concern in the U.S. The dramatic increase in prescription opioid use has led to disconcerting effects including misuse, abuse, and negative health consequences such as death from overdose and increased utilization of healthcare services. Even with heightened awareness of this issue, the majority of states have not developed strategies to help curb prescription drug abuse. Inappropriate prescribing of opioids is a key factor related to the misuse of these medications and related negative health outcomes. Prescribing high doses of opioids, concomitant opioid-opioid/opioid-benzodiazepine/opioid- Suboxone use, prescribing opioids for long durations, and prescribing long acting/extended release opioids for acute pain or for opioid naive patients are indicators of inappropriate prescribing. By creating formulary policies to limit access to opioid analgesic prescriptions under these conditions, policy makers and formulary managers have the potential to reduce the misuse and inappropriate prescribing of opioids, unnecessary healthcare utilization and overdose deaths. The proposed study uses Georgia and North Carolina Medicaid pharmacy and medical claims data from 2009 to 2014 to evaluate the impact of Georgia Medicaid formulary policy changes on three outcomes: 1) potential misuse and inappropriate prescribing of opioid analgesic medications; 2) utilization of healthcare services; and 3) deaths due to overdose. This study will directly measure the impact of formulary policy changes implemented by Georgia Medicaid in 2012/2013 designed to limit abuse, misuse, diversion and inappropriate prescribing, health services utilization and deaths from overdose. These policies include a limit on the number of prescriptions allowed per recipient per month, a change in the refill-too-soon rate from 75% of days' supply used to 85% of days supply used, and blocking concomitant use of any opioid and Suboxone. Study hypotheses are tested using descriptive statistics and panel data econometric analyses techniques. This innovative research is among the first studies to examine the impact of formulary policy changes on these three important contributors to the opioid crisis. Results of the study will provide evidence regarding the effectiveness of policy-level strategies to reduce misuse and inappropriate prescribing of opioids which is expected to lead to improved patient outcomes, decreased utilization of healthcare services and reduced costs of medical care. Results will inform key decision makers, allowing them to choose approaches that are most likely to reduce misuse of prescription drugs and drug overdose in states as well as to help states identify strategies that are effective in addressing a national crisis related to the abuse of prescription opioid analgesics.

 描述(由申请人提供)：处方阿片类镇痛剂的滥用和潜在的不适当处方在美国是一个日益严重的公共卫生问题。处方阿片类药物使用的急剧增加已导致令人不安的后果，包括滥用、滥用和负面健康后果，如过量死亡和医疗服务利用率的增加。即使提高了对这个问题的认识，大多数州也没有制定战略来帮助遏制处方药滥用。不适当的阿片类药物处方是与滥用这些药物和相关的负面健康后果有关的一个关键因素。处方大剂量阿片类药物、同时使用阿片类阿片类药物/阿片类药物苯二氮卓类药物/阿片类药物-亚伯酮、长期使用阿片类药物，以及为急性疼痛或阿片类药物幼稚患者开出长效/缓释阿片类药物是不适当处方的指标。通过制定处方政策，在这些情况下限制获得阿片类止痛药处方，政策制定者和处方管理人员有可能减少阿片类药物的误用和不适当处方、不必要的医疗保健利用和过量死亡。这项拟议的研究使用佐治亚州和北卡罗来纳州2009年至2014年的医疗补助药房和医疗索赔数据，以评估佐治亚州医疗补助处方政策变化对三个结果的影响：1)潜在的阿片类止痛药的滥用和不适当的处方；2)医疗服务的利用；以及3)因服药过量而死亡。这项研究将直接衡量佐治亚州医疗补助在2012/2013年实施的处方政策变化的影响，这些政策旨在限制滥用、误用、转移和不适当的处方、医疗服务的利用和过量用药造成的死亡。这些政策包括对每个接受者每月允许的处方数量进行限制，将补给太快的比率从使用天数的75%改为使用天数的85%，以及阻止同时使用任何阿片类药物和亚伯酮。研究假设使用描述性统计和面板数据计量分析技术进行检验。这项创新研究是首批考察处方政策变化对阿片类药物危机的这三个重要因素的影响的研究之一。研究结果将为减少阿片类药物滥用和不适当处方的政策一级战略的有效性提供证据，预计这将导致改善患者结局、减少医疗服务的利用和降低医疗费用。结果将为关键决策者提供信息，使他们能够选择最有可能减少各州滥用处方药和药物过量的方法，并帮助各州确定有效解决 国家危机与处方阿片类止痛药的滥用有关。